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Research studies in healthy populations may require enteric applications to deli− ver test meals/pharmaceuticals or to ob− tain intestinal secretion products. Use of radiological methods for controlling tube position and for insertion is widely accepted for both patients and healthy volunteers. However, radiological meth− ods remain controversial [1]. They carry radiation burden, which depends on the experience of the investigator and on ana− tomic conditions. Their use in healthy vo− lunteers should therefore follow careful ethical consideration, and alternative methods should be sought if necessary. In critically ill patients, sonographically guided enteric feeding tube position placement at the bedside has already been successfully employed [2]. Hence, in this prospective study we investigated the use of ultrasonography to confirm cor− rect intraduodenal tube placement on three occasions in 18 healthy volunteers (m/f 0.8; age (mean  SD) 27.8  5.4 years; BMI 22.27  1.88 kg/m2 ), leading to a total of 54 tube insertions. After an overnight fast and ingestion of 180 mL water, a poly− urethane enteric feeding tube (diameter 2.6 mm, length 120 cm) was blindly inserted in right decubitus position. The manoeuvre was performed under contin− uous aspiration of gastrointestinal juice. The required location of the tube was ver− ified by bedside measurement of aspira− ted fluid pH (pH 6.9  0.9). Transabdomin− al ultrasound (3.75−MHz Probe) visualiz− ed the enteral tube from the pylorus to the second part of the duodenum (medio− lateral of the gallbladder and upper trans− verse section in front of the inferior vena cava), both in upright and supine posi− tions (Figure 1). Visual detection was en− hanced by injection of 10 mL air followed by 10 mL saline (Figure 2). In 98 % of all in− sertions the tube was localized in the sec− ond part of the duodenum by ultrasonog− raphy. We believe ultrasonography is a feasible alternative to radiological meth− ods for monitoring postpyloric tube placement, and is preferable for studies in populations of healthy volunteers. Endoscopy_UCTN_Code_TTT_1AO_2AK

Placement control by transabdominal ultrasound of duodenal feeding tubes: a feasible alternative for trials in a healthy volunteer study population